Heroin maintenance for chronic heroin dependents

Area of Science:

• Addiction medicine
• Pharmacological interventions
• Public health

Background:

• Opioid dependence is a chronic relapsing condition characterized by continued use despite adverse consequences.
• Maintenance treatment aims for patient stabilization through pharmacological administration.
• Existing treatments include Methadone, Buprenorphine, and LAAM.

Purpose of the Study:

• To evaluate the efficacy and acceptability of heroin maintenance therapy versus methadone or other substitution treatments.
• To assess patient retention, reduction in illicit substance use, and improvements in health and social functioning.

Main Methods:

• Systematic review of randomized controlled trials comparing heroin (alone or with methadone) to other pharmacological treatments.
• Searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL) without language or publication year restrictions.
• Independent assessment of trial inclusion and quality, with data extracted and double-checked.

Main Results:

• Four studies with 577 patients met inclusion criteria; heterogeneity prevented cumulative analysis.
• Retention rates showed no statistical difference in two studies, favored heroin in one, and methadone in another.
• Relapse to illicit heroin use was lower in one heroin group; criminal offenses were reduced in one study comparing heroin prescription.
• Social functioning showed no statistical difference, though combined heroin and methadone improved multidomain outcomes in recent studies.

Conclusions:

• Non-comparability of studies prevents definitive conclusions on heroin prescription effectiveness.
• Favorable results for heroin treatment emerged from studies in comprehensive systems where methadone maintenance treatment (MMT) was readily available.
• Heroin prescription was primarily studied in patients who had previously failed MMT.